The shoulder joint is crucial and plays a very important role in carrying out everyday’s activities. Normally, the shoulder joint can be moved around in all directions without any pain and difficulty. However, when people experience pain while trying to move or lift the shoulder it is a condition known as adhesive capsulitis. In common language it is called “frozen shoulder” as the shoulder joint becomes stiff.

Causes

The medical term “adhesive capsulitis” is a perfect description of the condition. Adhesive means “sticky” and capsulitis means “damage or inflammation of the joint capsule.” Adhesive capsulitis develops when the connective tissue in the shoulder joint tightens and makes it difficult to move the shoulder. The tightening of the shoulder joint usually occurs when the shoulder joint is immobilized or in a sling for several weeks due to injury or surgery.

The causes of adhesive capsulitis are classified as:

• Primary reasons, where the cause is unknown

• Secondary reasons, caused as a result of surgery, illness, or trauma

Physicians are not sure why joint stiffening happens to some people and not to others. Adhesive capsulitis is found in people who have diabetes, therefore an autoimmune cause is suspected (when an immune system acts against the body’s organs).

People, who are older than 40, have diabetes, osteoarthritis, or disease of the cervical disc in the neck are more prone to develop this condition. Females are found to have a higher risk of developing adhesive capsulitis than their male counterparts. Open heart surgery and hyperthyroidism are other risk factors.

Adhesive capsulitis has three different stages or phases:

• Freezing stage: This stage lasts for two to nine months. This is the painful stage when the person experiences symptoms like gradual pain during movement of the shoulder, pain increases when lying on bed on the affected side, and the movement of the shoulder gradually decreases.

• Frozen stage: This phase is also known as the stiffened phase, and lasts for 4 to 12 months. The pain remains and stiffening of the shoulder gradually increases, everyday’s activities become difficult, and muscle wasting (decrease in size of skeletal muscles) can be noticed due to lack of use of the shoulder joint.

• Thawing stage: This is the recovery stage and lasts for 5 to 12 months. The pain and stiffness gradually subsides, and there is sufficient improvement in the shoulder movement.

Adhesive capsulitis is diagnosed based on symptoms the patient is experiencing and by physical examination. The doctor may apply mild pressure on the shoulder region to know where the pain is worse to determine the cause of the pain and stiffness. An X-ray or magnetic resonance imaging (MRI) scan will show the exact area of inflammation in the shoulder region.

Treatment

The treatment for adhesive capsulitis is aimed at limiting the symptoms experienced by the patient. A nonsteroidal anti-inflammatory drug and may be prescribed for pain.

Steroid injections in conjunction with physical exercise may help someone recover faster. A physician or the physiotherapist will teach a patient exercises that will help to loosen the stiffened shoulder joint.

Injecting sterile water directly into the shoulder joint can help stretch the tissues in the region and allow for easier movement.

Finally, if non-surgical treatment options do not show results, the doctor may perform arthroscopy surgery. This surgery is done under local anesthesia where the scar tissues are repaired inside and around the shoulder joint.

Effective exercises for adhesive capsulitis are:

• Stand upright and clasp your hands behind your back. Keep your arms straight and slowly lift your hands upwards. Hold this stretch for about 15 to 20 seconds and repeat it three to four times.

• Place one arm across your body, keeping it parallel to the ground. Then slowly pull your elbow towards your body. Hold this stretch for about 15 to 20 seconds and repeat it three to four times.

• Sit sideways in a chair, rest the affected arm at the back of the chair, and then swing it round slowly. Initially make small circles and gradually start making bigger circles. You want to be sure to swing the hand in both directions.

• Reaching exercise, this includes daily activities like reaching for shoes, brush, or coffee mugs that are placed up high.

While exercising the affected shoulder, it is important that the healthy shoulder is also exercised to maintain movement in that shoulder, as well.